Quo vadis is an Oration delivered by Dr George Paul at the National conference of the Indian Dental Association in Mumbai on february 11th 2012. It outlines the future of dentistry in India. the excerpts of the oral presentation are added to the slides as a brief note.

1. Whither Dentistry ?
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George Paul

2. What is Quo Vadis?
Several people have asked me the meaning of
Quo Vadis(1). Many in the older generation may
remember a Bata footwear by the same name. For
many people of my generation it was a popular
footwear from the famous house of Bata. Quo
Vadis simply means “Where are you going?”- in
Latin. Simple as it may sound, it has a profound
provenance. It has been used by hundreds of
writers and speakers to ask a question that is both
meaningful and rhetorical. There is an apocryphal
story that this was a question put to Jesus Christ
by St Peter. “To be crucified again” Jesus is
supposed to have replied. This seems to be the
predicament of dentistry in India.

3. Dr R Ahmed 1890- 1965
Dr R Ahmed qualified as a
Dentist from the University of
Iowa in 1910. On returning to
India he established the first
dental college in the country,
calling it the Bengal Dental
School. He funded the college
himself. Dr Ahmed then donated
the Dental College to the
Government of India in 1949. He
was a minister in the BC Roy
Government. He was also the
President of the Dental Council
and later President of the IDA.
He was later inducted into the
Pierre Fauchard Hall of Fame.
This Oration is dedicated to his
memory for the outstanding
contribution to Dentistry.

4. Journey of an
young teacher
Let me begin with
a small story. In
1952 a young
school teacher
from a small
village in the
South of India
travelled to
several cities
across the
country in search
of an opportunity
to do a post
graduation in
botany.

5. In 1952 ….
Unsuccessful, he was returning home via
Bombay (now Mumbai), when he
accidentally bumped into an old classmate
from his village in the YMCA. The teacher
was amazed to learn that his friend was
doing a four year course in „dentistry‟ in
Bombay. It was at a time when Dentist or
Dentistry was unheard of in the small
towns and villages of India. The only
dentist that the teacher knew of was a
dubious gentleman who wore a black robe
and pulled teeth at the weekly market.
The teacher accompanied his friend on a
visit to the Nair Hospital Dental College.
After being surprised that dentistry was
taught in a college for 4 years, he was
further taken aback by the 5 storey
buildings and the well dressed people
going about in bow ties and white coats.
On a whim, he joined the college.

6. Dr G Paulose
1929-2008
Four years later, the young school
teacher became a qualified dentist. The
only problem was that back in his
village, no decent family would give
their daughter in marriage to someone
who pulled teeth for a living. Finally he
married a shy girl from a nearby village
convincing them that he was some kind
of doctor. The salvaging fact was that in
any case he was also a former school
teacher.
This newly minted dentist was
my father!

7. From a foot peddle drill to Laser
dentistry- 60 years of progress
The story of my father Dr G
Paulose, who passed away in
2008 after practicing dentistry
for more than 50 years is more
or less the story of dentistry in
that period.. In his fifty years of
practice he saw the
establishment of dentistry as a
specialty of medical science
from being a mere semi skilled
vocation.

8. From barbaric tooth puller to
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sophisticated medical specialist
He grew with his
profession and saw it
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flourish. As a Dentist he
was recognized in
society as an important
health professional. He
even saw the
establishment of a
dental college in his
small city.
Courtesy Dr Rohera‟s clinic

9. The Dark Side
of practice
By the time of his death in
2008 he also witnessed the
first signs of decadence and
the dark side of the
profession. Proliferation of
colleges, cheap
advertisements,
unemployment, ethical
misconduct and several ills
had begun to creep into the
once respected profession
which he accidentally
stepped into 50 years before.
Dentistry had come a full
circle.

10. Unethical advertising and marketing – The result of
unhealthy competition caused by glut

11. „It was the best of Times. It was the worst of
times‟ Charles Dickens in The Tale of Two Cities

12. From 1910- 1985
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The number of dental colleges
stagnated in the first 50 years of
the twentieth century. There
were just two colleges for a
population of 350 million
population in 1947 when India
became independent. Less than
forty years later in 1985 there
were 21 dental colleges. This
was a 10 fold increase in 40
years.

13. Did this make a significant
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positive impact on health care?
Perhaps Yes!Template threshold
It was the
of the golden period of dentistry.
Dentistry went on to become a much sought after vocation
recognized by the medical fraternity and society. It reached its
pinnacle about 25 years ago. At the height of its glory
Dentistry became a competitive profession with entry only for
the brightest

14. Stats on increase from Independence through 1986 and
then to 2008
. Over the next 20 years the increase became more dramatic. The
number of college rose sharply to approximately 240 dental colleges.
This was an increase by 1200% in 20 years.

15. Did India’s Oral Health Care
improve?
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No!*
Today, dentistry is crowded by mediocrity. As a profession
it is losing its glamour. Hundreds of seats in Government
Universities are going vacant. Dental education has moved
back into the hands of the private sector where admissions
are open to candidates with moderate scholastic ability.
Thousands are jobless.
* GOI and WHO Conference of
Manpower resources, New Delhi

16. “There are three kinds of lies: lies, damned lies, and
statistics”.‟
A Government of India
and WHO collaborative
workshop on manpower
resources in Delhi in
2006 concluded that the
• George Bernard Shaw
increase in the number
of dentists had no impact
on the dental health care
in the country
• Benjamin Disraeli

17. How we can sometimes get things wrong! Projections
made in 2002 in an Indian Journal Dental Education
The amazing aspect of the
increase in dental institutions
were based on absolutely
faulty data and projections. A
n article on growth of dentistry
actually predicted that there
would only be 31,000 dentists
in the country by 2010 based
on the fact that there were
only 20,000 registered
dentists in 1990.

18. Wrong Expectations !!
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“Thus, the end of the twentieth century and the
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beginning of the twenty-first century saw an increase
in the number of enrollments. But in the near future
there may be a reduced number of people entering
these colleges as the rapid growth in the number of
dentists might tend to discourage some prospective
candidates who may feel that the increased
competition would limit their future earnings.”*
* Challenges to the Oral Health Workforce in India
**********, B.D.S., M.D.S.
Manipal College of Dental Sciences, Manipal Academy of Higher
Education (A Deemed University), Manipal, India

19. Growth in number of graduates from Indian dental schools*
In reality there were 200,000 dentists in 2012 as against the projected 30,000.
• 1960 1,370
• 1970 8,000
• 1980 13,930
• 1990 20,000
• 2002 26,000
• 2012 200,000

20. Was the Planning commission relying on false statistics when it said “2 lakh
Dentists needed”!!?
“As per a Planning
Commission study, the
country is short of six
lakh doctors, 10 lakh
nurses and 2 lakh
dental surgeons…….”
*Kounteya Sinha, TNN Dec 13,
2011, 04.02AM IST

21. The dangerous course of
Dentistry in Kerala
• A Case Study

22. Dental Colleges in Kerala *
• 1980- 1
• 1985- 1
• 1990-2
• 1995-2
• 2000-2
• 2005-8
• 2010-24

23. Demographics of Kerala 2011*
Population of Kerala – 33.38 million
Number of Dentists Registered in
Kerala- 10,000 (approx)
* Census figures 2011 and State Dental Council
registrations

24. Number of admissions
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1980-30
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1985-60
1990- 100
1995-100
2000-100
2005-300
2010-1400 - Projected
2015- ??? - Projected

25. Number of admissions per year in
Kerala

26. Recommended Dentist Population Ratio 1:7500
• Karnataka 1:2130
• Kerala 1: 3388 *
• Tamilnadu 1:4500 (approx)
* Most Dentists graduated from out of state. The new colleges had not started
graduating students
Source: Manpower resource utilization- GO and WHO 2006

27. Projected number of Dentists in
2015
16,000 (approx) for a population of 37 million
(approx)
• Kerala population is projected to grow at
less than 4.8% decadal grow. (population
growth from 2001-2011 is from 33.3 million
to 36.4 million) **
*http://en.wikipedia.org/wiki/Demographics_of_Kerala#CITEREF
GOK2005b
**: Census of India 2011

28. Points to be taken in projecting population growth in
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2015
All 24 CollegesTemplate
start graduating dentists
Assuming no more colleges are sanctioned
and seats are increased
Assuming same population growth rate
(likely to decrease)

29. Today several of these colleges have applied for
increase in seats. Even if we did not count these
increased seats, by 2020 the dentist population
ratio will be 1:1500 (approx). By 2030 the ratio will
become 1:733. With increase in seats or increase
in colleges it may end up as one dentist for every
street or even worse. Can a Dentist actually
survive as a professional???

30. Projection for
Kerala in 2030
• Conservative estimate 1 dentist for 1500
population if there are no more colleges and no
more increase in seats
• Possible ratio if seats are increased . 1 dentist for
733 population
• Dentist Population Ratio in the USA 1:1700
(approx)
• Significant number of dentists even if the colleges
are shut down to produce only 200 per year.

31. The result of
population glut
Thousands of dentists work for Accenture and
other multinationals around the country.
1000s of others work in pharmacovigilance,
BPO and other allied fields
Average salaries of fresh graduates seeking
employment in Private clinics (Rs 5000).
Average salaries of drivers with school
education (Rs4000-5000)

32. Dental Schools and Population globally
• USA 260 million- 61 dental schools
• Australia 30 million 9 dental schools
• China 1.3 billion- 102 dental schools
• India 1.21 billion - 291 dental schools

33. Is India’s Oral Health Care
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better than that of China?
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No!*
* GOI and WHO Conference of Manpower resources, New Delhi

34. 21% dentists in rural area with a population share of 73%
79% dentists in urban area with a population share of 27%

35. Why don’t dentists go to rural areas?
• Rural India has a different health priority-
malnourishment and starvation in addition to death
from tuberculosis, malaria, AIDS and preventable
diarrheal diseases.
• 250 of the 291 dental colleges are private institutions
churning out students who have paid large donations
and tuition fees. Does not make economic sense to
practice in rural India

36. Can Dental tourism justify increase in dentists?
I have no issue with dental tourism.
If dentistry needs to be a part of
the health programme in India, it
needs to have responsibility for the
terrible inequities in accessing
health in our country. A significant
part of income from health tourism
should mitigate the suffering of the
millions who do not have access to
basic health. The excess Dentists
may find meaningful incomes from
servicing foreigners but we also
have a responsibility to our own!

37. Health in Tribal India- Reality
There are two important factors why
dentistry cannot be meaningful in the rural
regions. One is the cost of private dental
education and the other is the inability of the
poor to pay for advanced dental treatment.
We will first need to understand and
assimilate the fact that dentistry is
expensive business and they can find a
meaningful market for their skills only in the
pockets affluence in our country. Most
Dentists today are the products of dental
institutions that cost an arm and a leg to
study in.
The poor just cannot afford dentistry unless
it is subsidized by the government. The rural
poor need protection from preventable
diseases including TB, Malaria and of
course hunger and malnourishment.

38. Why do we have so many
dental colleges??

39. Why did Dentistry alone face this
unplanned growth?
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Money! Money! Money!
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Unplanned Growth- reliance on faulty
statistics
Lack of response by the Government
despite protests
Corrupt Regulators

40. The Role of Money in Dental
Education
• Money required for starting Dental
College- Rs 5 Crores, 5 acres land and the
name of tem MDS persons (only names
required!)
• Returns on investment better than
Medicine or nursing- avaricious private
players
• Every license is up for sale

41. Dr. Ahmed‟s philosophy was: „„Education is the
responsibility of the State; but if no one is willing to
carry the cross, I will, for as long as I can‟

42. A Twist in the Tale- How R Ahmed was
funded????
• R Ahmed Dental
College
• Soda Fountain

43. A National Shame!
Collusion of
managements with
regulators and other
government
agencies have
caused
embarrassment and
shame to medical
and dental
education in the
country

44. Pop Stars of Dental regulation!
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Council heads came to
be treated like deities at
public places

45. Paper Clippings on Dentists on Strike- 2008. No
action
Public resentment
and opinions were
ignored by the
government and
regulators

46. Media Reports were ignored to
Lack of good jobs-Teething trouble
Shrabonti Bagchi| December 24, 2011.Times of India
• At 6 pm every evening, Abhishek
Chaitanya steps out of his house in
Thippasandra, Bangalore, and into a
glassfronted building that houses the
offices of a technology MNC and its
BPO unit. Chaitanya, 27, walks in, goes
to his desk and dons the traditional gear
of his tribe: a high-end headpiece that
gives him crystal-clear quality during
calls.
There's nothing out of the ordinary here
except that Chaitanya is a dentist by
qualification. Lack of good jobs and his
inability to start private practice pushed
him to become a call centre executive.

47. Dentists turn into BPOs- waste of
Training??
• Thousands of
young
Professionals
have become
BPOs in
major cities.
• A Waste of
Training??

48. So where are the new graduates
financially?

49. It is easy to be a Dentist- Click on the screen to see a popular
advertisement demeaning dentistry

50. Are we missing the message again? A recent newspaper
cutting- more dental colleges for a staturated state!!
• “ Those who
cannot
remember the
past are bound
to repeat it”
George
Santyana

51. Solutions!!??
“It is easier to fight for
principles than abide by them”
Adlai Stevenson

52. Will the new NCHRH make a difference?
A major restructuring of the
regulatory bodies. The NCHRH
is already on the anvil. It may
take a while to go through the
process of legislation, but it will
certainly bring a fresh
professional approach to the
statutory bodies. The checks
and balances seem adequate.
I do not believe that a
bureaucracy will be necessarily
above board. At least they are
less likely to be biased and
certainly can be more
accountable to the public and
the government. Graduating
dentists have every right to
make a decent living.

53. Are the regulatory bodies
cancerous??? A need for NCHRH!
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The classic case of the bar being
lowered to allow mediocrity can be found
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in the 2007 regulation of the DCI. Most
people are unaware that the minimum
marks required to gain entry into
dentistry has been lowered to 40% for
backward communities. It was previously
only for Scheduled Castes. This was
done insidiously to allow the children of
the rich and powerful with low marks.
Today Dentistry is the only professional
course where Backward communities
can gain entry with 40%. Nursing,
Pharmacy, Homeopathy and every other
professional admission requires 50% in
the qualifying examination for even
backward communities.

54. Two Elephants- Different Tasks (Tusks!)

55. Do we need a Flexner Report??
In 1900 a gentleman called Abraham
Flexner was faced with a similar situation
in the USA. There were too many Medical
Schools and the standards were
appalling. There was no uniformity or a
level playing field. Abraham Flexner was
appointed by the Federal Government
with a grant from the Carnegie
Foundation to study the matter in detail. In
1910 he recommended that 50% of the
colleges/ schools did not deserve to exist. Abraham Flexner
The Government acted on this
recommendation and on seats and
several measures including closed down
or merged colleges. It also imposed Even if 50% dental colleges are shut
restrictions exit examinations to down, there will still be a glut by 2030
rationalize medical education. !!

56. Hercules
• One of the labours of Hercules
was the cleaning of the horse
stables that accumulated
enormous amount of dung- the
Augean Stables. Hercules is
Diverting a river supposed to have done so by
diverting a river. That is the
challenge we have. There is so
much dung to be cleaned out and
we badly need a Hercules and
plenty of water to wash away the
filth.

57. We may need another „Tahrir Square‟

58. Or another „Occupy Wall Street‟
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59. Or another Anna Hazare movement

60. “All that is necessary for the
triumph of evil is that good men do
nothing. “
Edmund Burke

61. The thin edge of the wedge! Tamilnadu and
Kerala
• Tamilnadu is the only state where the IDA has
challenged the PG seat selection, corporate
advertisements, petitioned the Government for
moratorium on Dental Colleges
• Kerala filed a petition for writ when Internship was
abolished. Is currently fighting corporate
advertisements

62. What about the rest???
They can complain by singing the popular song
„Why this kolaveri di?‟

63. Why this Kolaveri…Kolaveri… Kolaveri ….Di
Click the screen to hear the song! (Kolaveri means „mental torture‟
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64. I have Hope!

65. सत्यमेव जयते (Truth Alone will
Triumph)
• Mundaka Upanishad, Mantra 3.1.6

66. Thank You
• The text of this Oration will be available
on the website of the HMA Trust at
• www.dentethics.com or
• on my personal blog site
www.maxfaxgp.blogspot.com